OBJECTIVE: The aim of this study was to test the psychometric properties of Korean version of 10 items of Drug Attitude Inventory (KDAI-10). METHODS: A total of 157 stabilized schizophrenic patients were entered into the study after completion of screening tests. They completed the KDAI-10. And then they were interviewed with various scales such as Subjective Response Scale (SRS), Positive and Negative Syndrome Scale (PANSS), Extrapyramidal Side Effects Rating Scale (ESRS), and Global Assessment of Functioning (GAF). Correlations of KDAI-10 with these scales were tested. RESULTS: The Cronbach's alpha used to measure the internal consistency of the scale, was high (0.83). Principal component analysis with varimax rotation produced 2 factors, which explained 50.37% of the total variances. The First factor including 6 items was the positive subjective feelings and the second factor including 4 items was the negative subjective feelings, which were identical to the original authors'. Individual item correlations with total scores were all statistically significant (r=0.48-0.72, p<.001). And correlations of KDAI-10 with SRS, PANSS, ESRS and GAF showed that they were significantly correlated. CONCLUSION: Although the results were not quite satisfactory, KDAI-10 was demonstrated to have good reliability and construct validity.
Humans ; Mass Screening ; Principal Component Analysis ; Psychometrics* ; Schizophrenia ; Weights and Measures

The rapid development of psychotropic drugs and great advancement in psychopharmacology during the past recent years has altered the strategy of pharmacotherapy for major psychiatric disorders, and in turn, an active development of various clinical practice guidelines or algorithm has taken place. However, there could be problems with applying the foreign guidelines directly to our clinical situation, due to the differences in racial characteristics, socioeconomic conditions, government policy, and clinical practices. In addition, the changes of circumstances outside of clinical situation in Korea may distort clinical practices and may go even against the trend of recent psychopharmacology. As a solution to such problems, Korean Medication Algorithm Project for Major Psychiatric Disorders (KMAP) was launched with the support from the Korean Society of Psychopharmacology and Korean Academy of Schizophrenia. However, since clinical practice guidelines and algorithms contain not only the advantages, but also disadvantages and risks, sufficient consideration must precede the development of algorithms. Hence, this review provides a discussion on the definition of clinical guideline and its limitation, its advantages and disadvantages, and the need for the development of clinical guideline in psychiatric field. Also, developing source, dissemination and implementation of clinical practice guidelines were also discussed. We hope that this review can make the purpose of KMAP clear and elicit the productive criticism on Korean algorithm.
Drug Therapy ; Hope ; Korea ; Psychopharmacology ; Psychotropic Drugs ; Schizophrenia

Atenolol is a beta1-selective adrenoreceptor blocking agent which is generally thought of as cardioselective, with little CNS action, because it has hydrophilic solubility rather than lipophilic. But recently, it has been reported that atenolol also can cause CNS side effect, especially in the patient with past neuropsychiatric history, old age, or underlying cerebral lesion. This 59-year-old female case demonstrated that atenolol could be an etiological agent of visual hallucination in a elderly patient with cerebral infarction.
Aged ; Atenolol* ; Cerebral Infarction* ; Female ; Hallucinations* ; Humans ; Middle Aged ; Solubility

Hypercalcemia is a relatively common complication of cancer that is clinically important because, left unattended, it is associated with symptomatic deterioration and even death. So hypercalcemia can afflict the quality of life and complicate management of the cancer patients with anorexia, lethargic, stuporous mentality, and severely dehydrated. Nonetheless, most cancers are at an advanced stage by the time hyperclacemia develops, many clinicians share doubts about the role of antihypercalcemic therapy in this situation. Furthermore, because the symptoms of hypercalcemia may mimic that of progressive malignant disease or the toxic effects of chemotherapy and radiation therapy, this may not always be recognized. So concerns are needed for active management of patients with malignant hypercalcemia. The authors reviewed the morbidity and mortality in 20 patients with malignant hypercalcemia out of 219 patients with bone metastasis, who were treated at the department of orthopaedic surgery, Catholic University Medical College from January 1989 through December 1992. The results were as follows. 1. The overall incidence of malignant hypercalcemia was 8.6% of bone metastases (20 out of 219 cases).: lung cancer 11.2% (10 out of 89 cases), breast cancer 22.5% (7 out of 31 cases), stomach cancer 6.3% (3 out of 47 cases). 2. The underlying diseases associated with hyprecalcemia were 10 cases of lung cancer(50%), 7 cases of breast cancer(35%) and 3 cases of stomach cancer(15%). Out of lung cancers, 8 cases were squamous cell cancers, the other 2 cases were oat cell cancers. 3. Only 7 out of 20 patients were treated with hydration, diuretics, steroid, calcitonin and mithramycin. And the mean survival duration after recognition of hypercalcemia was 11.3 weeks independent of treatment. In conclusion, the authors emphasize that inspite of grave prognosis, when treated actively, calcium lowering therapy may allow patients to be discharged during terminal period of their illness.
Anorexia ; Avena ; Breast ; Breast Neoplasms ; Calcitonin ; Calcium ; Diuretics ; Drug Therapy ; Humans ; Hypercalcemia ; Incidence ; Lung ; Lung Neoplasms ; Mortality ; Neoplasm Metastasis ; Neoplasms, Squamous Cell ; Plicamycin ; Prognosis ; Quality of Life ; Stomach ; Stomach Neoplasms ; Stupor

Objective: We revised the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP), first published in 2002 and revised in 2006, 2010, 2014, and 2018, to reflect recent progress in the treatment of bipolar disorder. Methods: The questionnaires consisted of 56 items for adult patients and 7 items for child/adolescent patients, and were used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of bipolar disorder. The review committee included 87 Korean psychiatrists and 40 child and adolescent psychiatry experts. Results: For treatment of manic episodes, a combination of a mood stabilizer (MS) and atypical antipsychotics (AAP), or monotherapy with MS or AAP were recommended as first-line treatments. Combinations of MS and AAP, or AAP and lamotrigine (LMT) were recommended as first-line treatments for depressive episodes regardless of the severity. Monotherapy with MS, AAP, or LMT were also first-line treatments for mild to moderate depressive episodes. For mixed features, a combination of MS and AAP, or monotherapy with AAP or MS were recommended as first-line treatments, and a combination of AAP and LMT, or MS and LMT were the first-line treatments for depressive mixed state. Conclusion The recommendations of the KMAP-BP 2022 have changed from the previous version, to reflect the evolution of the social culture and healthcare system in Korea and recent evidence regarding pharmacotherapy of bipolar disorder. The KMAP-BP 2022 provides clinicians with a wealth of information regarding appropriate strategies to treat patients with bipolar disorder.

Objectives: This study revised the Korean Medication Algorithm Project for Bipolar Disorder 2018 for rapid cycling. Methods: Questionnaires to survey the expert opinion of medication for rapid cycling were completed by a review committee consisting of 87 Korean expert psychiatrists. The experts’ opinions were classified into three categories based on the lowest category in which the confidence interval fell (6.5≤ for first-line, 3.5≤ for second-line, and 3.5> for third-line treatment). Results: The first-line treatments were a combination of mood stabilizers and atypical antipsychotics, atypical antipsychotics monotherapy, or mood stabilizer monotherapy. Furthermore, a mood stabilizer with lamotrigine therapy and an atypical antipsychotic with lamotrigine combinations was the first-line treatment for a depressive episode. The first-line medications in all episodes were valproate, lithium, quetiapine, olanzapine, and aripiprazole. Risperidone was the first-line medication in manic episodes and mixed states, and lamotrigine was the first-line medication for treating depressive episodes. Conclusion Compared to the surveys in 2018, the preference for atypical antipsychotics and lamotrigine has increased, and the modalities as a second-line treatment are more diversified.

Objectives: The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2022: children and adolescents. Methods: We performed a survey, using a questionnaire comprising 23 questions according to various situations facing children and adolescents with bipolar disorders. A total of 40 of the 60 experts in child and adolescent psychiatry responded to the survey. Results: The first-line pharmacotherapeutic strategies for manic and depressive episodes in children with bipolar disorders were a combination of mood stabilizer (MS) and atypical antipsychotics (AAP). The first-line medications selected for these children were aripiprazole (treatment of choice, TOC) and risperidone. The first-line pharmacotherapeutic strategies for manic episodes in adolescents were a combination of MS and an AAP (TOC), monotherapy with MS, and monotherapy with an AAP. Lithium, valproate, aripiprazole, risperidone, and quetiapine were selected as first-line medications for these adolescents. First-line pharmacotherapeutic strategies for depressive episodes in adolescents were a combination of MS and an AAP, monotherapy with MS, and monotherapy with an AAP. The first-line pharmacotherapeutic strategies for the depressive episodes in adolescents at high risk for bipolar disorder were a combination of MS and AAP and monotherapy with an AAP. Lithium, valproate, aripiprazole (TOC), quetiapine, and risperidone were selected as first-line medications for the treatment of depressive episodes in adolescents with bipolar disorder. Conclusion It is expected that the present KMAP-BP 2022: children and adolescents will give the direction and be usefully applied by clinicians to treat children and adolescents with bipolar disorders.

Objectives: In this study, we investigated and organized the maintenance-treatment strategies for Bipolar I and II disorders outlined in The Korean Medication Algorithm Project for Bipolar disorder 2022 (KMAP-BP 2022). Methods: The questionnaire sought to survey expert opinion on medication for bipolar disorders and was completed by a review committee consisting of 87 experienced Korean psychiatrists. It comprised 56 questions, and each question included various sub-items. The questionnaire for the maintenance treatments covered overall treatment strategies after acute mood episodes in bipolar I and II disorders, the choice of mood stabilizers and atypical antipsychotics and antidepressants, duration of medication, and treatment strategies for breakthrough symptoms. Results: In the case of bipolar I disorder, mood stabilizer monotherapy, atypical antipsychotics monotherapy, and a combination of mood stabilizers and atypical antipsychotics were selected as the first-line treatments. In maintenance management of bipolar II disorder, mood stabilizer monotherapy, atypical antipsychotics monotherapy, and combinations of mood stabilizers were selected as the preferred first-line treatments. Conclusion There has been a growing body of evidence that atypical antipsychotics have a greater preference than observed in the previous KMAP-BP of 2018. Also, monotherapy of mood stabilizers or atypical antipsychotics was more frequently selected in KMAP-BP 2022 than in the KMAP-BP 2018.

Objectives: The safety and tolerability of drugs are very important to ensure compliance and efficacy in the treatment of bipolar disorders. An expert opinion survey was conducted on treatment strategies in various special clinical situations, such as patients with significant weight gain, reporting characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling. Methods: A written survey that addressed treatment strategies related to safety and tolerability was prepared. The survey focused on significant weight gain, characteristic drug side effects, low drug adherence, treatment of pregnant and reproductive women, and genetic counseling. Eighty-seven experts in the review committee completed the survey. Results: In the case of weight gain occurring during drug treatment, it was considered preferable to replace the treatment drug with a drug that caused less weight gain, such as lamotrigine, aripiprazole, or ziprasidone. If there was a significant weight gain due to the treatment drug, it was considered preferable to intervene as soon as possible. In the case of hyperprolactinemia, it was considered preferable to change the drug. It was recommended that the drug beto discontinued in case of a benign rash as seen in patients treated with lamotrigine. For improving drug adherence, there was an increased preference for long-acting injections. It was also opined that antipsychotics should be used with great caution in pregnant or reproductive women. Conclusion Treatment strategies in various clinical situations related to the safety and tolerability of drugs for bipolar disorder have been described. It is hoped that this information would be useful in practical clinical situations.

Objectives: The present study was carried out to revise the guidelines for the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2018. The revision was carried out based on expert opinions to facilitate clinical decisions related to the treatment of bipolar disorders in patients with comorbid physical illnesses. Methods: A 56-item questionnaire was developed; a consensus was arrived at by 87 out of 93 experts (93.5%), on the pharmacological treatment strategies to be used in cases of comorbid physical illnesses accompanying bipolar disorders. Results: For patients with bipolar disorder exhibiting comorbid conditions, by consensus, lamotrigine, aripiprazole, and ziprasidone were recommended as the first-line strategies for metabolic syndrome; lamotrigine and aripiprazole were the recommended first-line strategies for cardiovascular problems; lithium and aripiprazole were the recommended first-line strategies for haptic problems; valproate, lamotrigine, aripiprazole, and quetiapine were the recommended first-line strategies for renal problems; and valproate and aripiprazole were the recommended first-line strategies for cerebrovascular problems or cerebral damage. Conclusion The present study is the most recent consensus among experts on recommendations for the treatment of bipolar disorders in patients with comorbid physical illnesses. Aripiprazole was recommended as the first-line pharmacotherapeutic agent in five comorbid physical conditions. This recommendation is similar to KMAP-BP 2018. Additionally, lamotrigine has been added as a first -line pharmacotherapeutic agent in patients with the metabolic syndrome, cardiovascular problems, and renal problems in the current algorithm.